Fentanyl has become a problem that’s difficult to ignore in Mexico. The powerful opioid, which triggered a national health crisis in the United States, is now making inroads across the border. “Fentanyl is being sold everywhere. Mexico is a producer and consumer [of the drug],” explains Silvia Cruz Martín del Campo, a doctor of pharmacology and researcher at the Center for Research and Advanced Studies at Mexico’s National Polytechnic Institute. “Adulterating traditional drugs with fentanyl is a practice that’s here to stay.”
Up until around 15 years ago, the main goal of adulterating drugs was to increase volume in order to achieve higher economic returns, says Cruz, who is the author of the book Lo que hay que saber de drogas (or, What you have to know about drugs). But since then, the market has expanded to incorporate new psychoactive substances that are synthetically made, and now compete with traditional drugs. “Faced with the reality of new psychoactive substances in the market, the challenge is competition: to offer new substances that have new effects, and that’s how the adulteration begins.”
While the consequences of the rise of fentanyl in the US and the health crisis caused by addiction to the drug have been well reported, little is known about the scale of the problem in Mexico. A 2021 report by the United Nations, however, did warn that the rise in heroin overdoses in Mexico was linked to fentanyl use.
Cruz explains that there are three main signs the situation is worsening: the number of overdoses in habitual users has increased, opioid consumption is no longer confined to the northern border and more production sites have been found across the country, a trend linked to migration. “No one can really claim we are just producers, where it’s produced, it’s consumed,” she says.
Getting a clear picture of fentanyl use is also difficult as drug users often don’t know they are even taking the opioid. “What people say they are consuming is one thing, what they are actually consuming is another,” she explains. “The consumer who buys crystal methamphetamine does not imagine that it contains fentanyl and they are not looking for it.”
No one can really claim we are just producers, where it’s produced, it’s consumedPharmacologist Silvia Cruz
Another sign that indicates fentanyl is now being sold across Mexico can be seen in public health. “People are beginning to have respiratory problems they didn’t have before or are getting hooked much more than before,” says Cruz, who adds that fentanyl is much more addictive than other substances, which makes addiction more likely as it can trigger withdrawal syndrome if it is not taken.
In a 2019 study on fentanyl use in the north of Mexico, Cruz and an interdisciplinary team of researchers analyzed 59 samples of white powder provided by heroin and crystal methamphetamine users in border cities. According to the study, 93% of the samples contained some type of fentanyl. This research group is now working on updating the findings, with a special focus on health impacts such as HIV, Hepatitis C and skin abscesses, which are linked to fentanyl use, and on reaching at-risk groups such as sex workers and migrants.
With fentanyl use on the rise, Cruz wants healthcare workers to act on the assumption that patients who have overdosed have consumed some type of fentanyl. This would involve loosening the restrictions on Naloxone, which is listed by the World Health Organization as a treatment against opioids, but categorized as a psychotropic by Mexico’s health authorities, meaning it can only be accessed via prescription.
“If you give Naloxone to a person who has not taken fentanyl, nothing happens. But if you give it to someone who has consumed it, they will have withdrawal syndrome, but you will save their lives. It has to be available everywhere,” says Cruz.
The researcher also warns that the common practice of injecting salty water to prevent overdose deaths, does not work with adulterated drugs. Typically this method can delay death for a short period of time, but says Cruz, “when heroin is combined with fentanyl, the salt injection provides no advantage.”